Nicole M Wigton, PA C

Individual provider Active NPI Medical Physician Assistant · Alpine, UT

NPI 1831526060 · NPPES record last updated Oct 2, 2013

Key facts

NPI
1831526060
Entity type
Individual (NPI type 1)
Primary specialty
Medical Physician Assistant 363AM0700X
License
7607471-1206 (UT)
Practice address
155 W Canyon Crest Rd Ste 200
Alpine, UT 84004-1966
Phone
(801) 763-9851
NPI assigned
Oct 2, 2013
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7607471-1206UTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alpine Family Medicine LLC Past
since Oct 19, 2015
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 7607471-1206 UT Yes

Addresses

Primary practice location

155 W Canyon Crest Rd Ste 200
Alpine, UT 84004-1966

Mailing address

857 Braddock LN
Alpine, UT 84004-1967
Phone (801) 216-4440

Other providers in Alpine, UT

All providers in Alpine, UT · Medical Physician Assistant in Utah

Sources for this page

Verify at the official NPI Registry.